Provider Demographics
NPI:1558735803
Name:SCULL, AMANDA LEE (DROT, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEE
Last Name:SCULL
Suffix:
Gender:F
Credentials:DROT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PORCHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-4516
Mailing Address - Country:US
Mailing Address - Phone:609-805-5445
Mailing Address - Fax:
Practice Address - Street 1:524 N WEST BLVD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-2845
Practice Address - Country:US
Practice Address - Phone:856-405-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00717500225X00000X
PAOC014121225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist